| NPI | 1992144331 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: LA AP07388) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: LA 64455-7388) |
| Enumeration Date | 2013-06-19 |
| Last Update Date | 2025-11-06 |